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Benign proliferative disease



Three common pathologies and often mixed in an individual case:


They may all show a continuous spectrum of abnormalities from benign through atypical to in situ carcinoma.

This is one of the trickiest areas of breast pathology and the text and illustrations below and on linked pages will give you anchor points within this spectrum.



Usual epithelial hyperplasia (UEH)







Usual type epithelial hyperplasia
Streaming of mixed population of small benign epithelial cells in this low power view Medium power view - an occasional mitosis should not put you off the diagnosis
Streaming of mixed population of epithelial & myoepithelial cells seen in this medium power view. Note slit like spaces. On an H&E myoepithelial cells can often appear dark and ovoid (arrows) CK 5/6 staining highlights the myoepithelial component of this mixed population



Usual type epithelial hyperplasia - example 2
Note peripheral slit-like spaces, streaming of ovoid shaped cells, the presence of cellular overlap and a heterogeneous pattern indicating two cell types. Arrows point to dark nuclei of admixed myoepithelial cells


Streaming of mixed population of small benign epithelial cells in this low power view Streaming of mixed population of epithelial & myoepithelial cells seen in this medium power view. Note slit like spaces. On an H&E myoepithelial cells can often appear dark and ovoid (arrows)

Usual type epithelial hyperplasia - example 2a. Note peripheral slit-like spaces, streaming of ovoid shaped cells, the presence of cellular overlap and a heterogeneous pattern indicating two cell types

Streaming of mixed population of small benign epithelial cells in this low power view Streaming of mixed population of small benign epithelial cells in this low power view stained for CK14


Usual type epithelial hyperplasia - detail of example 2a

Streaming of mixed population of small benign epithelial cells in this medium power view Streaming of mixed population of small benign epithelial cells in this medium power view stained for CK14

Usual type epithelial hyperplasia - example 3 Streaming of mixed population of small benign epithelial cells in this low power view
Streaming of mixed population of epithelial & myoepithelial cells seen in this medium power view. Note slit like spaces. On an H&E myoepithelial cells can often appear dark and ovoid (arrows)

Usual type epithelial hyperplasia - example 3
On the left arrows point to an area of columnar cell change without atypia. The CK 5/6 stain on the right shows abundant myoepithelial cells admixed with the proliferation
Streaming of mixed population of small benign epithelial cells in this low power view CK 5/6 immunostain showing miked proliferation


Apocrine metaplasia



  • Often associated with cysts - less frequently with calcs
  • May be seen focally within other lesions e.g. fibroadenomas
  • Intraduct benign epithelial proliferation which may extent to acini
  • Large cells with abundant eosinophilic cytoplasm, large nuclei with single prominent nucleolus
  • May form luminal papillary tufts
  • May be cytologically worrying but apocrine DCIS uncommon - this can be a difficult area diagnostically



Nodular focus of apocrine metaplasia
Nodular focus of apocrine metaplasia
Apocrine metaplasia


Apocrine metaplasia Apocine metaplasia - high power


High power (x60) view of the right hand image above - note prominent nucleoli
The left hand side of this photograph has been taken with the substage condenser lowered to exaggerate the cytoplasmic granularity
apocrine metaplasia


Apocrine metaplasia with luminal calcs
apocrine metaplasia



Apocrine metaplasia in the lower left portion of this image. The blue arrow points to a remnant of calc while the red arrow shows a tear in the section caused by another calc when the section was being cut.
apocrine metaplasia



Apocrine metaplasia
The blue arrows point to luminal calcs. Specimen X ray of the original core biopsy (right)
apocrine metaplasia apocrine metaplasia




Columnar Cell Change





Columnar cell change - note abundant luminal calcs
Columnar cell hyperplasia Columnar cell hyperplasia
Columnar cell hyperplasia Columnar cell hyperplasia




Columnar cell hyperplasia with architectural atypia
Columnar cell hyperplasia Columnar cell hyperplasia


Columnar cell change - early hyperplasia - note multilayering - this represents borderline flat epithelial atypia
flat epithelial atypia




See also... Image of the Quarter 2014/3 'Flat Epithelial Atypia' on this site on this site.


See also... Columnar cell hyperplasia and atypia (1) & Columnar cell hyperplasia and atypia (2) on this site.

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